Going down

Russia after the fall of the Soviet Union began to contract demographically. Its men live in poor health and die far younger than other Europeans. Its villages, towns and vast distant lands in the East are losing their inhabitants. There is no co-ordinated plan to deal with this

by Philippe Descamps

There is no need to travel to remote areas of Russia to find evidence of the country’s demographic crisis. Tver and its region (known as Kalinin from 1931 to 1990) are only a few hours from Moscow, but have recorded more than two deaths for every birth throughout the last decade. According to the preliminary results of the October 2010 census, Tver has 1.32 million inhabitants: in 20 years it has lost 18% of its population, more than 300,000 people.

Elderly widows pass through the elektrichka train out of Moscow, peddling a few kitchen utensils to supplement their meagre pensions. On the frozen bends of the Volga, fishermen dig holes in the ice. The bright, painted wooden houses of the villages contrast with the concrete blocks surrounding the capital. But most of the wooden houses have long been empty. “Half of the 9,500 villages in the region have fewer than 10 permanent inhabitants,” said Anna Chukina, a geographer at Tver State University.

Since the collapse of the Soviet Union in 1991, Russia has lost nearly 6 million inhabitants. Russians returning from “sister republics” and increased immigration have only limited the decline. Russia is twice the size of Canada or China but its population is 142.9 million (1). “Its greatest poverty is the sparseness of its population over an immense territory,” said Anatoly Vishnevsky, director of the Institute of Demography at Moscow State University.

The UN’s most pessimistic projections suggest the population could fall to 120 million by 2025 (128.7 million in their medium scenario), before a more rapid decline. Rosstat, the Russian federal service of state statistics, has a medium scenario of 140 million by that date.

In his annual state of the nation address in 2006, former president Vladimir Putin said the decline was “the most pressing problem” facing the country, and set priorities: “First, we need to lower the death rate. Second we need an effective immigration policy. And third, we need to increase the birth rate.” Faced with a relative lack of public concern, decision-makers and the media stress the need to increase the birth rate, ignoring the contradictions caused by the deep inequalities of the new Russia.

Could the policy be working? Even in winter, the snow-covered pedestrian roads of Tver and the banks of the Volga are packed with pushchairs, some on wheels, some on runners. Lydia Samoshkina, head of child protection at the Tver department of health is optimistic: “We see more and more families with two or three children. The birth rate has stopped going down over the last four or five years. Today the economy is going better. The state and the regional government help them.”

The government’s new, overtly pro-birth policy echoes the Soviet-era exaltation of the “socialist family”. The maternity capital subsidy allows the government to reserve the majority of state benefits for the parents of large families. The policy seems to have worked, as the number of births has been rising since 2007. The birth rate, which had fallen to 8.6‰ (children per 1,000 inhabitants) in 1999, rose to 12.6‰ in 2010, while the total fertility rate rose from 1.16 child per woman to 1.53.

Worryingly high death rate

Demographers remain sceptical. Financial incentives tend merely to bring forward people’s plans to have children. Mikhail Gorbachev’s pro-birth policy at the end of the 1980s created an initial rise in fertility before a marked decline. Over the long term, Russia’s birth rate is evolving in the same way as in most other industrialised countries. In the mid-1960s, the cultural revolution of birth control meant the total fertility rate fell below the replacement level of 2.1 children per woman. The only difference from the West was a lack of availability of contraception: the authorities were suspicious of the pill, so Russian women had to resort to abortion, first legalised in 1920, then outlawed by Stalin in 1936, then legalised again from 1955. Statistics remained secret until 1986, but it is estimated that there were 5.4m terminations in the Russian Federation in 1965, and more than four per woman until the mid-1970s. Contraception only became widely available after the end of the Soviet Union. Since 2007 the number of abortions has fallen to below the number of births, and continues to fall (1.29m in 2009).

Russia’s low birth rate may not be out of step with the rest of Europe, but the high death rate, particularly among men, is unique. Russian men have the lowest European life expectancy – 62.7 in 2009 (74.6 for women) – well below the global average (66.9 in 2008). Western life expectancy has increased by 10 years since the mid-1960s, yet Russians have still not regained the levels of 1964. People in Tver say population decline is attributable to young people leaving for the capital, less than 200km away, and it is true that the most enterprising head for Moscow or Saint Petersburg to find more lucrative and interesting work. But the number of emigrants is more than made up for by immigrants from other Russian regions and Central Asia. The main reason for the fall is male mortality, with male life expectancy (58.3 in 2008) lower than in Benin or Haiti (2).

Russia made rapid progress in the fight against infectious diseases in the 1950s. Thanks to health surveillance, vaccination and antibiotics, the Soviet Union had almost caught up with the West by the time Leonid Brezhnev came to power in 1964. Since then the gap has widened again and is now worse than at the beginning of the 20th century. The health system stopped being a priority when the Soviet economy began to stagnate, and it has proven ineffective against modern ailments such as cancer and heart disease. Central planning led to quantity rather than quality of health care, and insufficient funds were allocated to modernising facilities or developing the medical profession. The Soviet authorities were also unable to make people take responsibility for the health implications of their lifestyles.

After the collapse of the Soviet Union between 1991 and 1994, Russians lost almost seven years of life expectancy. While higher death rates have affected all the former communist countries, it worsens the further east you go, and this can be explained by examining the chaotic era of Boris Yeltsin’s leadership (1991-99). “The population was given a shock similar to what the Soviet Union went through between 1928 and 1934,” wrote Jacques Sapir (3), referring to the famine in Ukraine. In 1998 GDP was 60% of what it had been in 1991; investment was less than 30%. It was not until recently that capitalist Russia earned as much as it had at the end of the Soviet era (4). The privileged few – most from the former nomenklatura – pillaged public property and natural resources. The choices made by the early leaders, advised by the American Jeffrey Sachs and Frenchmen Daniel Cohen and Christian de Boissieu (chairman of the Council of Economic Analysis), turned Russia into the most unequal country in Europe, and indeed much of the world.

Rise in suicides

The decay was accompanied by a huge increase in violent deaths. The suicide rate among Russian men is currently the second highest in the world; the rate of deaths on the road (33,000 per year) and the murder rate are the highest in Europe (5). Russians have become disorientated and timid, and have lost their social connections. They are among the least likely in the world to be active members of clubs. This is true even in sport, said Anna Piunova, journalist for a mountaineering website: “Apart from the privileged classes, Russians no longer pay attention to their physical condition. Russian athletes still do well in competitions because of the elitist early selection policy, but there is no longer mass participation in sports.”

Vodka remains public health enemy number one. After the restrictions imposed under Gorbachev, consumption took off again in the 1990s. According to the WHO, almost one Russian man in five dies from alcohol-related causes (the global average is one in 16). More strong alcohol is consumed in Russia than anywhere else in Europe, and in quantities often leading beyond drunkenness.

Aboard the new Sapsan (peregrine falcon) high-speed train to Moscow, the gulf between the classes in the new Russia is evident. The new Russians tap away at their laptops, travelling at 250km an hour. To save 30 minutes on their journey, they pay six times the price of the masses crammed into the dilapidated carriages of the elektrichka. The heat wave in Moscow and southern Russia in the summer of 2010 confirmed the ineffectiveness of the health system; while the new nomenklatura holidayed on the Cote d’Azur or the Black Sea, at home there were 55,000 more deaths than the previous summer.

In education and health, wealthy Russians have access to expensive, high quality private services, while the vast majority make do with the badly rundown public sector. The Russian Federation is ranked 122 on the UN’s health index, lower than its 1970 ranking. The health reforms of 1993 tried to solve chronic under-investment and waste by replacing the centralised state system with mandatory health insurance, paid through salary contributions. But the introduction of uncontrolled decentralisation and competition between private insurance companies turned out to be ineffective and costly. While other countries raised their public and private health expenditure to respond to the health challenges of the modern world – it is more than 10% of GDP in most developed countries (11% in France, 16% in the US) – in Russia, where expenditure was already very weak before 1991, it was reduced to 2.7% of GDP in 2000, rising to 4.5% in 2010 (6).

The economic recovery and the return of the state have allowed some progress in Tver. Thanks to specific programmes aimed at providing treatment for heart disease and road accidents across more of the territory, the incidence of heart disease and road deaths is beginning to go down. Child mortality has been halved in 15 years and is now the same as in western countries (7.5‰ in 2010). The perinatal clinic in Tver is well-equipped, and a cardio-vascular clinic is being built, one of five planned for the region.

Improving public health

Health policy is changing direction, which is long overdue. Since 1 January 2011, the authorities have made a major effort to catch up by raising health contributions from 3.1% to 5.1% of salaries: “This measure should make an additional 460bn roubles available to the national health insurance fund. The money will initially be spent on renovating and computerising health centres, then raising health care standards,” said Sofia Malyavina, a health ministry spokeswoman. Creating 500 primary diagnostic centres should change things. Russians will be able to choose their doctor without having to spend a fortune.

There is still a huge amount of work to be done on prevention. The status of occupational medicine has been improved; a health passport allows teenagers to have a regular check up; “health schools” give advice to the elderly. In a sign of a change in approach, this April, Moscow hosted the first global ministerial conference on healthy lifestyles and non-communicable disease control. Despite all these programmes, it is hard to see how health can improve without social change, but reducing inequality by supporting the most vulnerable (people living alone, the retired, rural populations) and a fairer tax policy do not seem to be on the agenda.

Apart from some oil-producing parts of Siberia, and Moscow – which has ambitions to be a world city, with a population that has grown by 1.5 million in the last 20 years (11.5 million at the last census) – the only region with a population increase is the south. The mountain dwellers of the North Caucasus, who have terrified Russians since the Chechen wars, also produce the most children.

The challenge of developing Russia’s empty spaces has run up against the need to move away from a purely oil-based economy: that economy deepened the inequalities between areas rich in natural resources and those without. The Murmansk region in the Arctic Circle lost a quarter of its population in 20 years. Magadan, forever associated with the Kolyma gulags, is now home to only a third of the population it had in Soviet times. The Russian Far East, larger than the European Union, has only 6.4m inhabitants (down by 20%) and is in a “constant struggle against the void” (7). Its population density is not even a hundredth of its neighbour China.

The future of the monograd, towns devoted to a single industry, also remains uncertain. It would take huge investment to deal with the pollution and obsolescence of the copper smelting plants of Karabash, or the blast furnaces of Magnitogorsk, and dozens of similar towns. People talk about the “mass relocation of the unemployed” (8) to regional capitals or to towns with a more diverse economy.

Immigration is affected by the ambiguous attitude of the authorities, who try to find ways to respond to the demographic challenge, while pandering to public opinion, which is increasingly nationalist, even xenophobic. Putin praises the return of “fellow countrymen” and selective immigration for the educated and those who respect the law. The pool of ethnic Russians living in the neighbouring former Soviet republics is drying up, as most who wanted to return did so in the 1990s. Those who still want to come tend to be from deprived parts of Central Asia (Uzbekistan, Kazakhstan, Tajikistan) and the Caucasus, and usually work, in harsh conditions, in construction and road maintenance.

“Russia has always been multicultural,” said Alexander Verkhovsky, director of the Sova Centre, which researches racism in post-Soviet Russia. “In the USSR, we had a common citizenship, but also language and education. Today’s migrants, even if they come from the Russian republics, are increasingly cut off from Russian society. Fear means that all those who do not look Russian are seen as aliens.” The authorities denounce illegal immigration while doing nothing to combat the trafficking networks, or to set up genuine integration programmes.

Russian society seems unready to embark on an ambitious immigration policy. But the demographic phenomena are too insistent for Russia to reverse or even mitigate. It must find ways to adapt to a decline in its indigenous population.